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Sunday, April 3, 2011

Will pee for M&M's

My 2-year-old son is learning to pee on the potty. When I ask him if he would like to go to the bathroom, and he shouts M&Ms!! In our small community you will find a similar response from all toddlers, it is nearly universal. A behavior modification tactic, the children are offered candy as a reward. At our house it is one for sitting on the potty, two for peeing and three for poop... although we have not had any "poops" yet.

To the best of my knowledge this stems from a popular pediatrician group that many families use. It was the doctor that suggested this positive reinforcement system- of course with the reminder to always brush your teeth!

This has me thinking about how our practices influence the populations that we serve. Especially when it comes to non-evidence based measures, where personal style has an influence and regional preferences may exist. I can think of a couple of examples from Cardiology. For one stress testing. When selecting an exercise or pharmacologic stress you may choose your imaging modality. Depending on the strengths of your lab you may favor echocardiography or nuclear imaging. Personally I prefer stress echo because you can look at the valves and diastolic function (sans radiation), but you must have a great tech who can skillfully scan the patient as they hop off the treadmill. Another example is the management of acute MI (heart attack). Depending on where you live the standard may be primary PCI (going to the cath lab) or if you are in a rural area thrombolytics (clot busters). Also when in training the way we were taught seemed like the obvious and natural way- but then when emerging into practice there were some real surprises.

As far as I know (the little-people docs out there can set me straight!) the M&M potty training protocol has not been subjected to a randomized controlled trial. It probably just worked for my pediatricians kids- and so will it for the rest of us.

Now for the next challenge, his teacher says that he is ready for underwear at school. So our bag is packed for Monday- Elmo undies and extra pants for accidents!

5 comments:

Absolutely anecdotal experience colors the way we practice medicine. After iron supplementation in a patient with low iron levels helped her restless legs, I found myself ordering iron studies on several patients with similar complaints. It can be a good thing or a bad thing. In the absence of evidence, I think experience goes a long way to help someone be a better doctor. In some cases though, when someone deviates from evidence based medicine and standard of care because of their personal experience, it has the potential to be harmful.

And can I just say, potty training is so hard!! I've been potty training my daughter (2nd child) and we did M&Ms for peeing and ice cream for pooping in the potty. Now that she's been successful FINALLY with pooping in the potty several times, that incentive is getting downgraded to M&Ms and will eventually go away. I'm just relieved my daughter has finally figured out to make those connections between her brain and her muscles and is doing great with the potty training!!

We tried stickers and m&ms, along with several other things. All of those things only encouraged my son to go on the potty and in his pull-ups. Finally, we found that a reward for staying dry for a day would work. Unfortunately, that reward was a set of legos. But, after 2 weeks of legos, he's in underpants at home and at school-- the little mercenary...

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